CPMA FINAL EXAMS ALL ACTUAL QUESTIONS AND
ANSWERS SURE A+
✔✔Which statement is TRUE regarding 1995 and 1997 E/M Documentation
Guidelines?
a. The 1997 E/M Documentation Guidelines are more detailed using bullets and
shading to determine evels of exams .
b. The 1995 E/M Documentation Guidelines are never beneficial for specialists.
c. The 1997 E/M Documentation Guidelines are beneficial for general practitioners.
d. The 1997 E/M Documentation Guidelines are more detailed using bullets and
shading to determine levels of exams. - ✔✔d. The 1997 E/M Documentation Guidelines
are more detailed using bullets and shading to determine levels of exams.
✔✔Which OIG publication is released every year to identify various projects that will be
addressed during the fiscal year by the Office of Audit Services, Office of Evaluation
and Inspections , Office of investigations, and Office of Counsel to the Inspector
General?
a. OIG Work Plan
,b. Semiannual Report to Congress
C. Compendium of Unimplemented Recommendations
d. OIG Complaince Plan Guidance - ✔✔a. OIG Work Plan
✔✔Which CCM indicator allows a modifier to be appended to bypass an NCCI edits?
a. 0
b. 1
c. 9
d. None - ✔✔d. None
✔✔In the NCCI edits, what does modifier indicator nine represent?
a. A modifier is not allowed to bypass the NCCI edits
b. A modifier may be used to bypass the edits if the documentation supports the
modifier
c. Modifiers are not applicable he edits, the NCCI edit is not in effect
d. Only modifier 59 can be used to bypass the edit. - ✔✔c. Modifiers are not applicable
he edits, the NCCI edit is not in effect
✔✔In Corporate Integrity Agreement (CIA) does the OIG specify the Independent
Review Organization to be used?
a. YEs, the specific IRO will be named in the CIA.
b. Yes; the CIA will identify five IRO's that can be used for the CIA .
c. no, the OIG does not have any input on the IRO used under any circumstance.
d. No; the OIG does not specify the IRO to be used, but does retain the right to notify
the provider if they must select a new IRO. - ✔✔d. No; the OIG does not specify the
IRO to be used, but does retain the right to notify the provider if they must select a new
IRO.
✔✔Which of the following best represents an example of fraudulent activity?
,a. Waiving cost-shares or deductibles.
b. A pattern of claims for services not medically necessary.
c. Failure to maintain adequate medical or financial records .
d. Billing for services at a higher level than provided or necessary. - ✔✔d. Billing for
services at a higher level than provided or necessary.
✔✔What is the maximum penalty the OIG may seek for fraudulent claims?
a. 10,000 per item or service.
b. 15,000 per item or service.
c.10,000 per item or service plus three times the amount of over-payments.
d. 15,000 per item or service plus three ties the amount of over-payments. -
✔✔c.10,000 per item or service plus three times the amount of over-payments.
✔✔The OIG Work Plan is divided into seven parts. Which option is a part of the OIG
work plan most applicable to physician?
a. Medicare Part A and Part B
b. Public Health Reviews
c. Human Services Reviews
d. Corporate Integrity Agreements - ✔✔a. Medicare Part A and Part B
✔✔You Audit provider who is consistently reporting multiple units of CPT code 11042.
What references can you use to show the provider multiple units of CPT code 11042 is
not allowed and explain how it should be reported ?
a. CPT codebook and MUE table.
b. CPT codebook and NCCI edits
c. MUE table only
d. HCPCS codebook and NCCI edits - ✔✔a. CPT codebook and MUE table
, ✔✔The OIG determines a provider is guilty of submitting 10 fraudulent claims resulting
in $25,000 in over payments made to the provider. What is the maximum penalty the
OIG may seek?
a.$ 75,000
b. $100,000
c. $125,000
d. $175,000 - ✔✔d. $175,000
✔✔Which governing body is responsible for criminal prosecutions relating to the Privacy
Rule?
a. Office if Civil Rights
b. Secretary of State
c. Office of Inspector General
d. Department of Justice - ✔✔d. Department of Justice
✔✔What standard does the Privacy Rule set?
a. Pre-existing standards
b. Group health standards
c. Transaction and code set standards
d. Standards for how protected health information is used - ✔✔d. Standards for how
protected health information is used
✔✔CMS requires a legible identity for services provided/ordered. What type of signature
does NOT meet the legal requirements by CMS ?
a. Handwritten
b. Electronic
c. Rubber Stamp
d. All of the above are allowed by CMS - ✔✔c. Rubber Stamp
ANSWERS SURE A+
✔✔Which statement is TRUE regarding 1995 and 1997 E/M Documentation
Guidelines?
a. The 1997 E/M Documentation Guidelines are more detailed using bullets and
shading to determine evels of exams .
b. The 1995 E/M Documentation Guidelines are never beneficial for specialists.
c. The 1997 E/M Documentation Guidelines are beneficial for general practitioners.
d. The 1997 E/M Documentation Guidelines are more detailed using bullets and
shading to determine levels of exams. - ✔✔d. The 1997 E/M Documentation Guidelines
are more detailed using bullets and shading to determine levels of exams.
✔✔Which OIG publication is released every year to identify various projects that will be
addressed during the fiscal year by the Office of Audit Services, Office of Evaluation
and Inspections , Office of investigations, and Office of Counsel to the Inspector
General?
a. OIG Work Plan
,b. Semiannual Report to Congress
C. Compendium of Unimplemented Recommendations
d. OIG Complaince Plan Guidance - ✔✔a. OIG Work Plan
✔✔Which CCM indicator allows a modifier to be appended to bypass an NCCI edits?
a. 0
b. 1
c. 9
d. None - ✔✔d. None
✔✔In the NCCI edits, what does modifier indicator nine represent?
a. A modifier is not allowed to bypass the NCCI edits
b. A modifier may be used to bypass the edits if the documentation supports the
modifier
c. Modifiers are not applicable he edits, the NCCI edit is not in effect
d. Only modifier 59 can be used to bypass the edit. - ✔✔c. Modifiers are not applicable
he edits, the NCCI edit is not in effect
✔✔In Corporate Integrity Agreement (CIA) does the OIG specify the Independent
Review Organization to be used?
a. YEs, the specific IRO will be named in the CIA.
b. Yes; the CIA will identify five IRO's that can be used for the CIA .
c. no, the OIG does not have any input on the IRO used under any circumstance.
d. No; the OIG does not specify the IRO to be used, but does retain the right to notify
the provider if they must select a new IRO. - ✔✔d. No; the OIG does not specify the
IRO to be used, but does retain the right to notify the provider if they must select a new
IRO.
✔✔Which of the following best represents an example of fraudulent activity?
,a. Waiving cost-shares or deductibles.
b. A pattern of claims for services not medically necessary.
c. Failure to maintain adequate medical or financial records .
d. Billing for services at a higher level than provided or necessary. - ✔✔d. Billing for
services at a higher level than provided or necessary.
✔✔What is the maximum penalty the OIG may seek for fraudulent claims?
a. 10,000 per item or service.
b. 15,000 per item or service.
c.10,000 per item or service plus three times the amount of over-payments.
d. 15,000 per item or service plus three ties the amount of over-payments. -
✔✔c.10,000 per item or service plus three times the amount of over-payments.
✔✔The OIG Work Plan is divided into seven parts. Which option is a part of the OIG
work plan most applicable to physician?
a. Medicare Part A and Part B
b. Public Health Reviews
c. Human Services Reviews
d. Corporate Integrity Agreements - ✔✔a. Medicare Part A and Part B
✔✔You Audit provider who is consistently reporting multiple units of CPT code 11042.
What references can you use to show the provider multiple units of CPT code 11042 is
not allowed and explain how it should be reported ?
a. CPT codebook and MUE table.
b. CPT codebook and NCCI edits
c. MUE table only
d. HCPCS codebook and NCCI edits - ✔✔a. CPT codebook and MUE table
, ✔✔The OIG determines a provider is guilty of submitting 10 fraudulent claims resulting
in $25,000 in over payments made to the provider. What is the maximum penalty the
OIG may seek?
a.$ 75,000
b. $100,000
c. $125,000
d. $175,000 - ✔✔d. $175,000
✔✔Which governing body is responsible for criminal prosecutions relating to the Privacy
Rule?
a. Office if Civil Rights
b. Secretary of State
c. Office of Inspector General
d. Department of Justice - ✔✔d. Department of Justice
✔✔What standard does the Privacy Rule set?
a. Pre-existing standards
b. Group health standards
c. Transaction and code set standards
d. Standards for how protected health information is used - ✔✔d. Standards for how
protected health information is used
✔✔CMS requires a legible identity for services provided/ordered. What type of signature
does NOT meet the legal requirements by CMS ?
a. Handwritten
b. Electronic
c. Rubber Stamp
d. All of the above are allowed by CMS - ✔✔c. Rubber Stamp
